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All South Africans will be covered by the National Health Insurance (NHI) by 2025, which will begin in a phased approach from 2019, President Cyril Ramaphosa told healthcare sector representatives on Friday.

He urged health professionals and the industry meeting at the Council for Scientific and Industrial Research (CSIR) in Pretoria to see universal health coverage as an investment and not a consumptive expense.

Ramaphosa’s consultations with the healthcare industry come as the public and interested parties have until various dates in September to comment on three key pieces of legislation set to shake up the healthcare sector - the NHI Bill and the Medical Schemes Amendment Bill both released in June; and the Health Market Inquiry preliminary report, published in July.

Ramaphosa said he would like to emerge from the meeting on Friday having gained consensus on a number of issues, ahead of a health summit to be held at an unspecified date.

There has been concerns about the affordability of the NHI, with the Davis Tax Committee in March 2017 finding that according to its scenario planning a 4% increase in payroll tax and a 3% increase to the value added tax (VAT) rate would be needed to fund universal health coverage.

Ramaphosa said that an NHI will bring down costs as there will be economies of scale on medicine and equipment.

He praised the public health system which he said had done a lot to improve life expectancy and reduce HIV infections since democracy.

But the president said he is concerned about staff and medical equipment shortages in public facilities and the uneven access to healthcare by higher income and lower income households.

“We must accept the reality that the quality of service cannot be improved by a fatigued and demoralised workforce,” Ramaphosa said.

He pointed to Scandinavian countries such as Norway and Sweden which introduced universal healthcare saying they saw this as an investment in the health of their workforce and population.

“I am determined that this matter should be addressed so that we should be defined as a country that cares for the people who are most vulnerable when they are sick,” Ramaphosa promised.

The meeting was closed to the media shortly after Ramaphosa’s address to allow the industry to hold a frank conversation with the president.